1. Pennington Nutrition Series
Healthier lives through education in nutrition and preventive medicine Pub No. 32
Type 1 Diabetes
Overview
Type 1 Diabetes (DM) is usually diagnosed in
children and young adults. It was previously
referred to as “Juvenile Diabetes.” In this type of
diabetes, the body is not able to produce insulin.
Insulin is required by the body to use sugar, in the
form of glucose. Glucose is the basic fuel for
cells. Insulin’s role is to take the glucose from the
blood and carry it into cells where it can be used
to provide energy for the body to do work.
About Insulin
Insulin is a hormone made by the beta cells of
the pancreas. With each meal consumed, beta
cells release insulin in order for the body to be
Insulin cannot be taken in a pill form able to use or store the glucose it gets from
trough the mouth. If it were to be foods. With Type 1 Diabetics, however, the
consumed this way, it would be broken pancreas is no longer able to make insulin.
down during digestion just like The beta cells have been destroyed. Insulin
normal proteins in your food. shots are thus required in order for the body
Insulin must be injected into the to use the glucose coming from meals.
fat under the skin in order for it to
get into the bloodstream.

2. Characteristics of Insulin
There are three characteristics of insulin:
Onset: is the length of time before insulin reaches the
bloodstream and begins lowering blood glucose.
Peaktime: is the time during which insulin is at maximum
strength in being able to lower blood glucose.
Duration: is how long insulin continues to lower blood glucose.
The Four Main Types of Insulin
Rapid-acting insulin Intermediate-acting insulin
Regular or short-acting insulin Long-acting insulin
Rapid-acting
Onset: Begins to work in about 5 minutes
Peaktime: Peak is about 1 hour
Duration: Continues to work for about 2-4 hours
Regular/short-acting
Onset: Reaches the bloodstream within 30 minutes after injection
Peaktime: Peaks anywhere from 2-3 hours after injection
Duration: Effective for approximately 3-6 hours
Intermediate-acting
Onset: Reaches the bloodstream about 2-4 hours after injection
Peaktime: Peaks 4-12 hours later
Duration: Effective for about 12 to 18 hours
Long-acting
Onset: Reaches the bloodstream 6-10 hours after injection
Duration: Usually effective for 20-24 hours
There is also a very long-acting insulin, known as glargine, which starts to lower blood glucose
levels about one hour after injection and keeps working evenly for 24 hours after injection.

3. Fine-Tuning Blood Glucose levels
Premixed Insulin
Premixed insulin is also an option for individuals There are many factors that influence blood
with Type 1 Diabetes. It is helpful for individuals glucose levels, including:
who have trouble drawing up insulin out of two
bottles or for individuals who have difficulty in
reading the correct directions and dosages. What you eat
How much and when you exercise
Information on Storage of Insulin
Where you inject your insulin
Manufacturers recommend storing
insulin in the refrigerator; however, When you take your insulin injections
injecting cold insulin sometimes makes
the injection more painful. Illness
You can store insulin to be used Stress
immediately at room temperature.
Insulin stored at room temperature will
last for approximately 1 month.
If purchasing several bottles at once,
keep one at room temperature to be used
immediately. Store the remaining bottles
in the refrigerator so that they will
keep longer.
Information on Storage of Insulin
Do not store insulin near extreme heat or extreme cold.
Never store in the freezer, direct sunlight, or in the glove
compartment of a car.
Check the expiration date. This is especially important
for a larger batch.
Make sure that the insulin looks normal before drawing it
into the syringe.
If there is any discoloration, particles, “frosting”
or crystals in the solution, do not use it.
Return the unopened bottle to a pharmacy
for an exchange and/or refund.

4. Conditions that can arise from Type 1 DM
Hypoglycemia
Hyperglycemia
Ketoacidosis Symptoms of Hypoglycemia
Shakiness
—HYPOGLYCEMIA— Dizziness
Hypoglycemia is a condition Sweating
that occurs due to low blood
glucose. It happens from time Hunger
to time in everyone with diabetes.
It is sometimes referred to as an
Pale skin color
“insulin reaction.” It must always
be treated immediately.
Sudden moodiness or behavior
changes, such as crying for no
Establish a schedule for checking blood apparent reason
glucose levels as directed by a physician.
Blood glucose should be checked if there Clumsy or jerky movements
are any symptoms of hypoglycemia present.
The presence of low blood glucose level Seizure
requires immediate treatment.
Difficulty paying attention
If you are unable to check your blood
or confusion
glucose, a good rule of thumb is:
“When in doubt, treat”
Tingling sensations around
the mouth
Treatment Should Be Immediate
If hypoglycemia is not treated immediately, it can How to Treat Hypoglycemia
result in a loss of consciousness. Loss of
consciousness requires immediate treatment The fastest way to raise blood glucose
such as injection of glucagon or emergency and treat hypoglycemia is with some
treatment at the hospital. Glucagon, like insulin, form of sugar. Any of the following
would work:
is injected but serves a different purpose.
Glucagon helps to raise blood glucose levels. A
3 glucose tablets
physician can prescribe glucagon and give 1/2 cup of fruit juice
directions on its use. 5-6 pieces of hard candy

5. —HYPERGLYCEMIA—
Hyperglycemia is a technical term Potential Causes of Hyperglycemia
for high blood glucose. It can be a
serious problem if not treated. Eating more than planned
Hyperglycemia can happen when
the body has too little, or not enough Exercising less than planned
insulin, or when the body is not able
to use insulin properly. Stress of an illness, such as the
cold or flu
Blood glucose levels can be
Other stresses, such as family
reduced by exercising.
conflicts or dating problems
However, if the blood glucose
level is above 240 mg/dl, check
the urine for ketones. If there
are ketones present, then
exercise is not recommended.
Ketones are acids that build up in the blood. They appear
In addition, cutting down on the
in the urine when the body doesn't have enough insulin.
amount of food may help.
Ketones can poison the body. They are an indicator that the
If exercise and changes in diet
diabetes is getting out of control. Ketones are present in high
do not help, then talk with a amounts in a condition known as Ketoacidosis.
physician about either changing
the amount of insulin or the
timing of the injections.
Potential Causes of Hypoglycemia
Thirst or a very dry mouth
—KETOACIDOSIS—
Ketoacidosis results from a failure Frequent urination
to treat hyperglycemia. It rarely
occurs in individuals with Type 2 High blood glucose levels
DM. It is a very serious condition
that can lead to diabetic coma, High levels of ketones in the urine
or even death. Treatment for this
condition usually takes place in a Constantly feeling tired
hospital. You can prevent the
condition by learning what the Dry or flushed skin
warning signs are and by checking
your blood and urine regularly. Nausea, vomiting, or abdominal pain
Shortness of breath
Difficulty paying attention

6. Possible Causes of Ketoacidosis
Not getting enough insulin: The dose was not enough or
Ketoacidosis is dangerous and
perhaps the body needed more insulin than usual because
serious. If you have any of the
of illness. Without sufficient insulin, the body begins to
mentioned symptoms, contact your
break down fat for energy.
health care provider immediately or
go to the nearest emergency room.
Not enough food: During illness, appetite and food intake
An important note: NEVER
is reduced and this may result in high ketone levels.
exercise when urine test shows
Skipping meals can also lead to ketoacidosis.
ketones and the blood glucose is
high. This combination can mean
An insulin reaction: When blood glucose levels fall too that the diabetes is out of control.
low, the body must use fat for energy. If testing shows
high ketones in the morning, its likely that the person
may have had an insulin reaction while asleep.
The Pennington Biomedical Research Center is a world-
Who Should Check? renowned nutrition research center.
The ADA recommends blood glucose checks Mission:
if you have diabetes and are: To promote healthier lives through research and education in nu-
trition and preventive medicine.
Taking insulin or diabetes pills
The Pennington Center has several research areas, including:
On intensive insulin therapy
Pregnant Clinical Obesity Research
Having a hard time controlling your Experimental Obesity
blood glucose levels Functional Foods
Health and Performance Enhancement
Having severe low blood glucose levels Nutrition and Chronic Diseases
or ketones from high blood glucose Nutrition and the Brain
levels Dementia, Alzheimer’s and healthy aging
Having low blood glucose levels without Diet, exercise, weight loss and weight loss maintenance
the usual warning signs
The research fostered in these areas can have a profound impact
on healthy living and on the prevention of common chronic dis-
Pennington Nutrition Series Pub No 32
eases, such as heart disease, cancer, diabetes, hypertension and
Authors: osteoporosis.
Heli Roy, PhD, MBA, RD
Shanna Lundy, BS The Division of Education provides education and information to
Beth Kalicki the scientific community and the public about research findings,
Division of Education training programs and research areas, and coordinates education-
Phillip Brantley, PhD, Director al events for the public on various health issues.
Pennington Biomedical Research Center
Steve Heymsfield, Executive Director We invite people of all ages and backgrounds to participate in the
3/06; Rev. 10/09; Rev 3/11 exciting research studies being conducted at the Penning-
ton Center in Baton Rouge, Louisiana. If you would like to take
part, visit the clinical trials web page at www.pbrc.edu or call
http://www.diabetes.org (225) 763-3000.